Abortion pill chaos after flurry of rulings. Michigan providers say they won’t stop

• A federal appeals court late Wednesday restricted access to the abortion pill as a lawsuit over it goes through the courts 
• It’s the latest twist in a complicated set of court cases over the drug that was first approved for abortion in 2000
• Michigan abortion providers say they will continue to provide medication abortions for the time being

The abortion pill mifepristone will continue to be available for now in Michigan, but it could soon be sharply limited — banned by mail-order and offered only through the first seven, rather than 10, weeks of pregnancy — under the latest in a flurry of federal court decisions. 

And after an appeals court ruling late Wednesday, the pill’s fate is now even more likely to end up in front of the U.S. Supreme Court.

While cases out of Texas and Washington state have yielded conflicting and confusing rulings in the past week, Planned Parenthood of Michigan said Thursday it will continue to provide medication abortion to 11 weeks pregnancy as it has been for years — at least for now.

“This morning and today, we are providing mail order medication abortions,” Dr. Sarah Wallett, chief medical operating officer for Planned Parenthood of Michigan, which operates 14 clinics statewide, told Bridge Michigan.

Related:

• April 7: Whitmer: Abortion pill remains ‘legal in Michigan,’ despite judge’s ruling
• April 3: Abortion access expands with online prescriptions in Michigan. Some fear risks
• March 22: 'Abortion pill' under legal scrutiny; what it means in Michigan.

The leaders of metro Detroit’s Northland Family Planning Centers and Scotsdale Women’s Center, said their clinics, too, are trying to sort out legal limitations but have not stopped providing medication abortions. The clinics also provide mifepristone up to 11 weeks in pregnancy — a protocol deemed safe by the World Health Organization.

“It’s chaotic. It’s ridiculous,” Shelly Miller, executive director of Scotsdale, said Thursday of the series of court decisions.

Miller, Wallet and Renee Chelian, founder of Northland, said they are weighing whether doctors can continue to prescribe mifepristone later than seven weeks into pregnancy, but do so off-label.

“We are evaluating the options, and it keeps changing anyway,” Miller said.

Genevieve Marnon, legislative director for Right to Life Michigan, said that Michigan providers prescribing the pill after seven weeks would be violating the appeals court’s ruling. But, she acknowledged, it’s doubtful there would be any enforcement in the near term, given the quick-changing legal landscape.

It’s the latest twist in a series of court decisions over mifepristone, the first of a two-part medication regimen commonly prescribed; indeed, so-called abortion pills are used in more than half of the abortions in Michigan.

There is widespread consensus in the U.S. medical community that mifepristone has been both safe and effective since it was first approved by the Food and Drug Administration in 2000. But late last week, a federal judge in Texas appointed by President Donald Trump ruled that the drug was improperly approved by the FDA, essentially ordering that it be removed from the market. 

The judge, Matthew Kacsmaryk, delayed the effect of his order to give the FDA time to file an appeal, which it did. Within hours of Kacsaryk’s ruling, a federal judge in Washington state reached the opposition conclusion in a separate case and ordered U.S. authorities not to make any changes to the pill’s availability.

With those two trial courts in conflict, the Texas case was appealed to the Fifth Circuit Court of Appeals. Late Wednesday, a three-judge panel from that court, which included two Trump appointees, blocked that part of Kacsmaryk’s order that would have taken the pill off the market, at least for now, but also imposed restrictions on access to mifepristone while the suit proceeds. 

Most notably: the appellate judges declared that the drug could no longer be mailed to patients and could only be prescribed by a doctor while the case goes through the courts. Those restrictions rolled back FDA rules from 2016 that were intended to make it easier for people to obtain the pill.  

Those new restrictions prompted the U.S. Department of Justice to file an emergency appeal to the U.S. Supreme Court. U.S. Attorney General Merrick B. Garland said the Biden administration was appealing “to defend the FDA’s scientific judgment and protect Americans’ access to safe and effective reproductive care.” 

Abortion providers in Michigan said they were frustrated by legal challenges to a medication that has long had the confidence of physicians. 

“I have zero questions about what the right health care for my patients are, but I'm spending my time talking to lawyers to see what we can legally do,” said Wallett of Planned Parenthood. 

Mifepristone is also known as RU-486 and sold under the brand name Mifeprex. The drug is the first half of the two-pill regimen to effect an abortion up to 10 weeks or so into a pregnancy. It blocks progesterone, triggering the lining of the uterus to break down, according to Planned Parenthood.

Taken up to 48 hours later, a second drug, misoprostol, starts contractions to expel the pregnancy tissue — much like a miscarriage.

The FDA has approved the use of abortion drugs through 10 weeks of pregnancy, or 70 days or less since the first day of a patient’s last menstrual period. 

The drug combination is used in more than half of abortions in the United States and in Michigan. In 2021, 15,367 Michigan abortions, about 51 percent, were “medical (nonsurgical) abortions,” according to the Michigan Department of Health & Human Services.

Michigan providers say they could continue to offer medication abortions using only the second drug, misoprostol, though the effectiveness rate of using that medication alone is slightly lower.

“It is unacceptable that yet another court has chosen to endanger the health and futures of millions of patients who depend on mifepristone for abortion care,” Planned Parenthood of Michigan’s CEO Paula Thornton Greear said in a statement. “Twice this week, the federal judiciary has ignored both science and the law.

The Fifth Circuit’s order allowing mifepristone to be used only in the first seven weeks of pregnancy is “outrageous,” said Chelian, founder of Northland Family Planning Centers, which operates three clinics in metro Detroit.

Like Wallett, Chelian said the ruling won’t stop abortions, but if allowed to stand it could make it more difficult on women who are more than seven weeks pregnant. Those patients may have to undergo a surgical abortion in a clinic instead of taking a pill in their home, she said.